Agreement in TAPSE in TTE (m-mode) and TOE (2D)
Research type
Research Study
Full title
Is there agreement in tricuspid annular plane systolic excursion measured by m-mode transthoracic echo and 2D transoesophageal echo?
IRAS ID
170509
Contact name
Henry J Skinner
Contact email
Sponsor organisation
Nottingham University Hospitals
Duration of Study in the UK
0 years, 11 months, 28 days
Research summary
Transoesophageal echocardiography (TOE) yields clearer images of some cardiac structures compared to transthoracic echocardiography (TTE). However there is inadequate data to recommend a reliable method to assess right ventricle (RV) function with TOE [1]. Tricuspid annular plane systolic excursion (TAPSE) is the movement of the tricuspid valve annulus towards the RV apex and represents RV contractility in the long axis [2]. TAPSE in healthy subject is 25mm [3] and TAPSE <15mm signifies impaired RV function [2,4]. From the transthoracic apical 4-chamber view, M-mode can accurately measure annular excursion as it occurs along the scan-line. The standard TOE view to assess the RV is the mid-oesophageal 4-chamber view. In this view, TAPSE occurs almost at right-angles to the m-mode scan line. This causes two problems; firstly the excursion is underestimated and secondly the annulus does not remain within the (single) scan-line throughout the cycle. TAPSE measurements from this view are therefore meaningless.
The aforementioned limitations can be overcome by measuring TAPSE in 2D. In 2D, observation of movement is angle-independent and there are multiple scan-lines allowing visualisation of the tricuspid annulus throughout the cycle. However, in order to measure TAPSE in 2D, the existing measuring software has to be used in a novel way (see below). To our knowledge, this method has not been described.
We aim to show acceptable agreement of measuring TAPSE between the two methods.
There is currently inadequate data to recommend a reliable method to assess right ventricle (RV) function with TOE. This may not matter if the patient undergoes concurrent TTE (as in outpatients), but it is relevant in other settings (cardiac theatre or ICU) where it is not feasible to perform a concurrent TTE or transthoracic windows are inadequate.REC name
East Midlands - Nottingham 1 Research Ethics Committee
REC reference
14/EM/1325
Date of REC Opinion
29 Dec 2014
REC opinion
Favourable Opinion